Workers’ Compensation Insurance and Occupational Disease/Injuries
As you may already know, Workers’ Compensation insurance is one of the most widely accessible entitlement programs in the US today. It is most commonly referred to as a series of paid benefits available to any employee who is injured on the job or becomes ill as a result of performing their jobs. Federal and state laws require all employers to provide Workers’ Compensation benefits to all employees, and it is usually available through a private carrier. Additionally, employees are paid these benefits regardless of whose fault the accident or injury is.
Workers’ Compensation insurance can cover occupational diseases and injuries like asbestosis/mesothelioma, repetitive motion injuries, and even injuries to the immune system due to exposure to any number of allergens or toxins. In the following workers’ comp case study, for example, my client sustained severe and debilitating injuries to her immune system due to work-related exposure to latex.
Latex allergy case involving hospital worker
A hospital employee, we’ll call her Jane, recently filed a Workers’ Compensation case with us due to how sick she has become because of an allergenic reaction to latex encountered on her job. Beginning in 1986, Jane began working for a hospital pediatric oncology/hematology unit as a staff member. She was well-liked by her fellow employees and was considered to be an excellent employee.
However, she began experiencing a variety of symptoms such as breathing difficulties, discomfort at work, and severe headaches. At that time, Jane was referred to the employee health department, where she would be diagnosed with a severe latex allergy after numerous tests. This allergy has impacted her life severely and resulted in ongoing health problems. She initially took a 6-month leave of absence from her job, receiving no TTD (Temporary Total Disability) while she was not working.
In order to avoid any contact with latex, when she returned to the job, she took a position in the hospital’s call center. Three months later, she encountered another allergenic reaction to latex while working the call center and left that department. Although her employer subsequently set her up to work from home with cables and wires attached to a computer modem, the cables were coated in latex and she had yet another flare-up. As a result, she can no longer work at all, as her latex allergy has severely damaged her immune system.
Today, Jane cannot work, and she is currently taking a number of medications as a result of her allergy to latex. These medications include Adavair, Albuterol, Nascort, Singulair, and Toanex. As if these weren’t enough, she has been forced to carry an Epinephrin pin with her at all times.
On a closing note, where the above case is concerned, we demanded “X” amount in order to settle the case once and for all, as well as see to it that Jane is compensated for what she has endured and how her financial earnings and future have been severely impacted by her work-related injuries. This is why it pays to have a workers’ compensation attorney on your side; we can help maximize your benefits and medical care and help settle your case to that you get the best outcome possible.
Filed under Case studies, Occupational Diseases/Injuries by 
Recently I had a workers’ comp case where my client suffered from a very severe and complex ankle injury and had to undergo 2 surgeries over a period of several months. Even after the surgeries, she still required ongoing medical care and had limited range of movement, resulting in her inability to work certain jobs.
When her initial workers’ comp benefit was calculated, she was awarded a weekly TTD benefit that was a gross underpayment when you looked at all the care she needed and the specifics of her case. After a careful review of the case, it became obvious that her benefit was mis-calculated due to her position as a waitress – where a lot of the money she brought in was due to TIPS.
You see, many times servers and bartenders and other workers who bring in significant income from tips end up experiencing improper wage calculations and mis-calculations of benefits owed when in pursuit of workers’ comp cases. The same is true for workers who work off commissions or receive large bonuses.
In my client’s case, we were able to get her the benefits she deserved (we ended up securing higher TTD benefits, plus TPD and PPD as well), and we were also able to re-calculate her wages to reflect a more accurate picture of what she had been making at the time of the accident. This is why it pays to have a workers’ comp attorney helping you with your case – we see these situations often and can often help you maximize your benefits.
In any case, the tip of the day is this: To anyone bringing in significant income from tips, commissions, or bonuses, KEEP GOOD RECORDS in the event that you are one day injured and have to pursue a workers’ comp case!
Filed under Foot/crush injuries, Income benefits, Maximizing your settlement by
Recently I had to handle a situation for a client when the workers’ compensation insurance company denied treatment for migraine headaches caused by medication given to my client by an authorized physician.
In this case, my client hurt his back badly about a year previously when he was lifting HVAC equipment. For several months, the insurance company fought us in our attempt to get proper medical treatment but eventually I was able to get him to a good doctor who scheduled him for surgery to repair a large herniated disc in his lumbar spine.
Post surgery, my client developed complications when fluid began to build up in the spinal canal. The surgeon prescribed a strong medication to help drain the fluid and prevent an infection. Unfortunately this strong medication resulted in migraine headaches.
Although the migraine headaches were new, the law in Georgia is clear that medical treatment and medications necessary to treat a complication from a compensable injury is also compensable and must be paid for by the insurance company. And, in fact, the insurance adjustor originally assigned this case, authorized my client’s pharmacy to dispense his migraine medication
Several weeks into the treatment regimen, a new adjustor was assigned to this claim. The new adjustor decided that the migraine headaches were not related to the work injury and she canceled the pharmacy authorization. Suddenly, my client was left without medication to treat his frequent and painful migraine headaches.
As you might imagine, this development left my client in a great deal of pain. I immediately got on the phone with the adjustor but she would not change her position. I then wrote the treating doctor to request a statement from him that “connected the dots” and related the migraine headaches to the original work injury. I also got on the phone to the defense attorney representing the employer/insurer to demand that my client’s prescription be approved. It took about 5 phone calls until I finally got the defense attorney to call me back – he acknowledged that our position was correct and he was able to convince the adjustor to start the medication authorization again.
This type of arbitrary action by workers’ comp insurance adjustors is all too common. Adjustors come and go and a reasonable, knowledgeable insurance claims person can be replaced by someone new who is inexperienced, stubborn or even vindictive. As a claimant’s lawyer, I make every effort to stay on top of problems like the one my client experienced and to take whatever steps are necessary to solve these problems.
The economic downturn has led to an increase in companies that try to cut payroll costs by illegally classifying workers as independent contractors rather than employees. This practice costs the government billions in lost revenue and can leave workers with nothing when they are hurt on the job or are laid off. The Internal Revenue Service and 37 states are starting to crack down.
It can be a blurry line 
between employee and contractor status, but it is important to know which you fall into. These are some tips for determining your status to make sure you receive the benefits you deserve and to prevent yourself from being taken advantage of by companies engaging in unlawful practices.
Companies Worked For – A key indicator of independent contractor status is when the worker does the same work for multiple companies.
Expense Reimbursement – Independent contractors are more likely to have expenses that are not reimbursed. Employees are typically reimbursed for business-related expenses.
Workers’ Investment – Independent contractors most often have a significant investment in the services they use, most significantly an office or work space, and are not provided tools, equipment, or supplies by employers.
Pay Periods – Independent contractors are typically paid by the job, while employees are paid by the hour, week, or month.
Pay Rate – Independent contractors make a profit or loss on the job, while employees receive paychecks regardless of whether the company makes money.
Permanency – If a worker is hired with the expectation that the job will be permanent, or until further notice, they are generally an employee.
Benefits – Independent contractors are typically not provided benefits, while employees receive benefits such as insurance, pension plans, vacations, or sick days.
Have you been injured on the job and are not sure what category of worker you fall into? Feel free to use the Free Case Evaluation form on this website to discuss your particular circumstances with an experienced workers’ comp attorney.
Filed under Employee vs. independent contractor by
Last July, I wrote a post on this blog about how your Facebook profile could be used against you in your case. The Georgia State Board of Workers’ Compensation will allow defense counsel to introduce status updates and pictures to challenge your assertions that you are injured and cannot work. This is in addition to the surveillance and other investigation that defense counsel use to impugn your credibility.
More recently I have learned of a case where the insurance company’s defense lawyer used a “request for the production of documents” to demand that an injured claimant turn over his personal computer to be examined by the lawyer. As you may know, when you file a workers’ compensation claim in Georgia, both sides are allowed to demand information from the other per Georgia’ “discovery rules.”
Apparently, in this case, the insurance company believes that the claimant’s hard drive will reveal damaging information – perhaps photos, evidence of work or physical activity, or it may be just a fishing expedition.
Now, this was not my case, and at this point, at least, this demand for the claimant’s computer has not become a regular part of defense counsel’s arsenal, but I think that this type of request sets a very bad precedent. I learned about this case in a monthly meeting I attend with a few other claimant’s lawyers who get together to discuss current developments in the law and winning strategies. All of us in last month’s meeting were somewhat taken aback by this discovery request as well as the presiding judge’s approval of the request. We all agreed that if any of use are involved in a case and the insurance company asks to look at our clients’ computers, we will fight this request vigorously. More on Judge Orders Injured Worker to Allow Insurance Company to Examine His Computer
The malpractice of a Georgia workers’ compensation company, which has been compared to the fraudulent actions of Enron, will ultimately have a large negative impact on innocent citizens.
The State Insurance Commissioner’s office has begun a criminal investigation into SEUS, an insurance company that provided workers’ compensation insurance to dozens of Georgia communities.
Suspicions of SEUS, short for Southeastern U.S. Insurance Inc., began when department analysts learned that the company had engaged in questionable business practices with a hunting club it owned in Seminole County. SEUS had invested $10 million in the hunting club when the company was in no financial condition to make such an investment. Upon investigation, the department also discovered that SEUS was inflating company assets while drastically understating liabilities.
In October 2009, Fulton County Superior Court Judge Thomas R. Campbell, Jr., ordered SEUS, which at the time held over 200 workers’ compensation policies and provided coverage to dozens of towns and school boards in Southern Georgia, into liquidation.
Georgia Insurance Commissioner John Oxendine was named as the liquidator. Following investigations into the company’s financial transactions, Oxendine compared the bookkeeping methods of SEUS’s former chief executive, M. Clark Fain III, to those of Enron.
Companies like Enron and SEUS, which are motivated by corporate greed, inexcusably disregard the large negative affect their misconduct will have on innocent citizens. Oxendine’s office has taken over the operation of the workers compensation insurer and is now authorized to sell off its assets to pay claims. SEUS has also been banned from involvement in further business.
Filed under Blogs, Recent developments, Workers' Comp Fraud by
Although Georgia’s workers’ compensation system is supposed to foster an environment where legitimately injured workers can get needed treatment and then return to work, the reality is much different. It has been my experience that workers’ compensation practice is just about as adversarial as divorce practice. Often justice and fair play take a back seat to “winning” and efforts by employers insurance companies to avoid paying benefits.
Case in point. This week I received the following email from a young woman who works at a factory in north Georgia:
Where I work I have been told that carpel tunnel is not recognized as a workman’s comp injury if I wasn’t having problems with numbness before. Is this correct?
The short answer is “no, this is not correct.” Repetitive motion injury (often resulting in a diagnosis of carpel tunnel syndrome) is a very common work injury, especially for factory workers performing manual labor with their hands.
Any employer who tells an employee that “carpel tunnel is not recognized as a workers’ comp. injury” is either very misinformed or downright dishonest. More on Employee Gets Bad Information About Legitimate Job Injury
